Avoiding Infection after Intestinal Transplant

Immunosuppressant medications, which are necessary to prevent rejection of transplanted organs, make it more difficult for an intestine transplant recipient's body to fight infections. Symptoms such as a cough or fever, which may have gone away on their own before a transplant, can be a warning sign of an infection. If your child is an intestine transplant recipient and has any signs or symptoms of infection described on this page, you should call his or her primary physician or transplant coordinator immediately. We recommend that a doctor evaluate a patient to determine if he or she has an infection and how the infection, if any, should be treated. Even if your child’s doctor diagnoses and treats the infection, it is important that you tell your child’s transplant coordinator about it. This is important for your child’s long-term care.

Dealing With Fever

Fever in a child taking immunosuppressants is an important warning sign that there may be an infection or organ rejection. Even if a patient's fever lasts only a few minutes, they need to contact their primary physician or transplant coordinator. If the fever subsides, it does not mean that the cause of the fever (usually an infection) is gone.

Taking a Temperature

You should check your child’s temperature every morning for the first three months after intestinal transplant and at any time he or she feels ill or hot, or has shaking chills. A glass mercury thermometer placed under the tongue for three minutes or an electronic digital thermometer can be used. If your child’s temperature is 101oF (38.3oC), call your transplant coordinator immediately. If your child’s temperature is between 100oF (37.8oC) and 101oF (38.3oC) for 24 hours, contact your transplant coordinator. If your child feels ill, do not wait 24 hours before calling the transplant coordinator – a coordinator should be contacted right away.

Possible Responses to Fever

After receiving information from an intestinal transplant patient with a fever, a transplant coordinator from the Hillman Center for Pediatric Transplantation gives the patient advice about how to treat the fever. You may be asked to take your child to the local hospital emergency department. Your child’s doctor should contact the transplant coordinator or the on-call coordinator to make sure all the necessary tests are ordered during your child’s stay at the hospital. Evaluating the situation may require a culture of blood, throat tissue, or urine; a chest X-ray; and tests of liver enzymes, digestive enzymes, blood glucose, and other factors. Your child’s symptoms and physical condition will help determine what tests are necessary.

You should remember to call a transplant coordinator before your child begins taking any new prescription or over-the-counter medication.

When to Use Acetaminophen or Aspirin

An intestinal transplant recipient should not take acetaminophen (Tylenol) or aspirin for a fever unless his or her transplant coordinator approves the use of the drug. If your child takes acetaminophen or aspirin while his or her temperature is mildly elevated – between 99.0oF (37.2oC) and 100.9oF (38.3oC) – the medicine will lower the temperature; no one will ever know if the temperature would have gone up. Just because the fever is gone does not mean that the cause of the fever, usually infection, is also gone.

After your child has been examined by a doctor and has had the necessary tests to investigate the cause of the fever, he or she may take medicine such as acetaminophen to lower the fever. Anyone with a fever should drink extra fluids and rest.

Patients may take acetaminophen occasionally for muscle aches, headaches, etc. However, it should not be used on a regular basis. Remember to call the transplant coordinator if your child has unrelieved headaches or pain.

About Post-transplant Lymphoproliferative Disorder (PTLD)

Post-transplant lymphoproliferative disorder (PTLD) is a cancer-like condition that occurs in about two percent of transplant recipients. It is usually due to infection by the Epstein-Barr virus. Epstein-Barr virus, or EBV, is the same virus that causes mononucleosis.

The most common symptom of EBV infection is swelling in one or more lymph glands. Swelling is most commonly found in the neck but can also involve the tonsils and the lymph glands in the armpit, groin, and elsewhere. An infected patient also may have a fever. Report any lumps (masses) or swelling to your child’s transplant coordinator immediately. Although a swollen gland is a normal response to an infection, this can be a very dangerous in an immunosuppressed intestine transplant patient. Patients may need to be hospitalized immediately so that a biopsy of the mass can be performed.

If the biopsy shows that a patient has PTLD, a transplant surgeon adjusts immunosuppressive medications. Transplant recipients may also receive intravenous medication. The transplant surgeon may order tests to determine if there are any internal masses. In most cases, PTLD can be treated by reducing the dose of immunosuppressive drugs the patient is receiving. If this strategy does not lead to resolution of PTLD, the Institute has many other approaches to treat this disorder.